Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122400000X | Denturist | 9884 | SC |
NPI | 1992372841 |
---|---|
Provider Name | Johnnie Bruce Catoe |
First Address | Charleston, SC 29414-9274 |
Second Address | Charleston, SC 29414-9274 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/06/2021 |
Last Update Date | 09/06/2021 |